AB0503 GENICULAR ARTERY EMBOLIZATION IN THE MANAGEMENT OF PERSISTENT JUVENILE IDIOPATHIC ARTHRITIS OF THE KNEE: A CASE REPORT
Authors: M. Badii, D. Parhar, S. Badii, D. Liu
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Genicular artery embolization (GAE) is rapidly gaining popularity for treatment of patients with recurrent hemarthrosis following knee arthroplasty, and for pain relief in mild-to-moderate osteoarthritis (OA) [1]. Despite the growing evidence of the safety and efficacy of GAE in improving pain and disability in OA, it has yet to be reported in the treatment of patients with inflammatory arthropathy, such as rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA). <h3>Objectives</h3> To apply GAE on an adult patient with oligoarticular JIA of the knee and refractory to biologic therapy, and measure improvement of pain symptoms. <h3>Methods</h3> A 40-year-old woman with history of oligoarticular JIA presented with progressively worsening right knee pain and swelling. She had tried several treatments in the past including oral analgesia (NSAIDS, acetaminophen, and opioids), multiple intra-articular steroid injections, therapeutic arthrocentesis, multiple DMARDs (MTX, SSZ, LEF), and had been on biologic therapy (adalimbumab) for the past 8 months, with no noticeable improvement from any of these strategies. Prior to GAE she had pain score of 8/10 on VAS, and Oxford Knee Score (OKS) of 25. The GAE procedure was subsequently performed on an outpatient basis under conscious sedation. A four French angled tip catheter was advanced into the distal SFA and angiography was performed. This demonstrated characteristic synovial hyperemia ("blush") of the synovium along the medial joint space supplied by the musculoarticular branch of the descending genicular artery (DGA), as well as the lateral synovium supplied by the inferior lateral genicular artery (ILGA). Super-selection of the DGA was performed using a 1.9 French microcatheter, with repeat angiogram confirming synovial hyperemia. After administration of intra-arterial nitroglycerin, the DGA was then embolized with 1.0 cc of 100 – 300 μm Embospheres (Merit Medical Systems, South Jordan, UT). Post-embolization super-selective angiogram confirmed a "pruned-tree" appearance of the DGA branches, with no further hyperemia, in keeping with a successful embolization. <h3>Results</h3> The patient tolerated the procedure well and was discharged home same-day. At 6 and 12 months follow-up, the patient continued to report substantial improvement in her symptoms with a pain rating of 1 out of 10 on both rest and mobalization. Her OKS was 35 at 12 months. Her right knee remained in remission on Adalimumab for 12 months post procedure. Figure 1 shows the comparison of the pre and post GAE fat saturated T1 image. Pre GAE, there were synovial thickening and enhancement of the knee capsule. As shown in Figure 1, at 12 months post GAE significant retraction and devascularisation of the synovium has occurred. <h3>Conclusion</h3> We report the first case of GAE in a patient with inflammatory arthropathy, which showed dramatic and sustained reduction in pain. Though the efficacy, safety, and long-term clinical durability still need further evaluation in the context of inflammatory arthropathy, the positive result in this case posits an exciting avenue for further investigation into the role of transarterial embolization in rheumatologic disease. <h3>Reference</h3> [1]Heller DB, Beggin AE, Lam AH, Kohi MP, Heller MB. Geniculate Artery Embolization: Role in Knee Hemarthrosis and Osteoarthritis. RadioGraphics. 2022 Jan;42(1):289-301. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.